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Carotid stenting is a minimally invasive procedure used to treat ischemic stroke caused by carotid artery stenosis, where narrowed arteries reduce blood flow to the brain. This technique involves placing a stent to expand the artery and restore proper blood flow. It is particularly beneficial for patients who have experienced a transient ischemic attack (TIA) or minor stroke and are at high risk for a more severe stroke. For those not suitable for traditional surgery, carotid stenting offers a crucial alternative to prevent future strokes.
Dr. Manish Taneja

Stroke Specialist, Supreme Vascular and Interventional Clinic

Introduction to Carotid Stenting and Stroke

Carotid stenting is performed to restore blood flow to the brain. Your brain’s primary blood supply is the two carotid arcteries in your neck. About 20% of strokes are caused by atherosclerosis (hardening of the artery) in the carotid artery, meaning the carotid artery becomes blocked. Stenting reopens the artery and restores blood flow.

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Who is Predisposed to Carotid Artery Stenosis?

Carotid artery stenosis is also known as carotid artery disease. It’s a major cause of ischemic stroke and caused by plaque formation in the carotid arteries. Understanding the risk factors can help you determine if you need to be screened for carotid artery stenosis, which can then be treated with a stent before it causes a stroke. Risk factors include:

  • Age. Carotid artery disease is more common in people over 50.
  • Hypertension
  • Type 2 diabetes
  • High cholesterol
  • Smoking
  • Drinking
  • Family history of carotid artery stenosis
  • High fat diet
  • Lack of exercise
  • Obesity

People with these risk factors should be screened.

 

Indications for Carotid Stenting: When Do You Need It?

Carotid stending is typically indicated if you have 70% plus blockage but no symptoms, or if you have symptoms. It is less invasive than carotid endartectomy, which involves exposing the artery and removal of plaque, so is commonly recommended for people at high surgical risk.

 

Recognizing Symptoms of Carotid Artery Stenosis and Impending Stroke

Because most people aren’t screened, you need to understand and recognize potential symptoms of carotid artery stenosis. Typically there are no specific symptoms of carotid artery stenosis until a Transient Ischemic Attack (TIA, a mini stroke) or stroke occurs.

The following symptoms should be considered a medical emergency:

  • Temporary loss of or blurring of vision
  • Slurred or unclear speech
  • Loss of feeling in the face, arm, or leg
  • Confusion and difficulty concentrating
  • Sudden onset headache
  • Dizziness or fainting
  • Loss of movement or coordination
  • Paralysis of an arm or leg on one side.
  • Weakness or clumsiness of an arm or leg on one side.

In a TIA, symptoms go away entirely within 24 hours, with the attack itself lasting between a few minutes and an hour. If the symptoms don’t go away, it’s a stroke. However, you should seek medical attention even if symptoms disappear, as a TIA may be a warning sign of a stroke and there are often things doctors can do to prevent stroke or further TIAs.

 

Diagnosis: How Carotid Artery Stenosis is Detected

Because carotid artery stenosis has no specific symptoms, it has to be detected through screening. Screening may be done if you have risk factors and is routine after a TIA or a stroke while establising a cause.

Diagnosis is done via ultrasound imaging of your neck to take images of the carotid artery and branches. These images show the extent of plaque build up and how badly the artery has been blocked, and help indicate whether it is the cause of the TIA.

 

The Carotid Artery Stenting Procedure: What To Expect

Carotid artery stenting is most often done under local anesthesia, with optional sedation, because the doctor needs to monitor your neurological status. A stent is either inserted into the femoral artery in the groin and moved through the body or inserted directly into the carotid artery itself. Not everyone is a candidate for transcarotid stenting as it depends on the conformation of your carotid artery.

The procedure usually takes from 30 minutes to 2 hours and most people have to stay in the hospital for a day or two. You may be requested to stop certain medications and should stop smoking for a week or two beforehand.

 

Post-Stenting Recovery: Rehabilitation and Monitoring

Most people have femoral stenting, with the catheter inserted through the groin. If this is the case, you should avoid stairs as much as possible for the first two to three days, and not drive, do yard work or similar heavy chores, or play sports. These restrictions can often be lifted after 2 days.

You will need to change the bandage on your dressing and keep an eye on it. If the incision bleeds or swells, lie down and put pressure on it for 30 minutes. If it doesn’t stop, go to the ER. Some patients are asked to take aspirin or clopidogrel for a period of time to reduce the risk of clots forming in the stent. Downtime, however, is minimal.

 

Follow-up Care

Plaque build up can recur after stenting and in some cases get worse. You should make lifestyle changes such as improving your diet, exercising as you can, and reducing stress. You should stop smoking – if this is a problem for you, talk to your doctor about a cessation program. Limit your consumption of alcohol.

 

Other Minimally Invasive Stroke Treatment Options in Singapore

Stenting is generally the easiest and least invasive treatment for carotid artery disease. Other minimally invasive options include intracranial stenting (which is used for people with recurring stroke symptoms), mechanical thrombectomy, and lifestyle changes that can help prevent strokes or prevent them from recurring.

At Supreme Vascular and Interventional Clinic we have the expertise to treat your carotid artery disease and lower your risk of having a stroke. Stenting is the least invasive treatment method and the one we most often recommend for carotid issues. If you have been diagnosed with carotid artery stenosis or have risk factors, contact us to make an appointment today with our stroke specialist, Dr. Manish Taneja.

Your Guide to Prevent a Second Stroke

Prevent strokes with these lifestyle changes and medical management. Learn the risk factors and how to reduce them in our stroke prevention guide.

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We’ve Got You Covered for Specialized Stroke Screening, Prevention, and Management

 

Imagine heart attacks where the blood flow to your heart is blocked. Similarly, a stroke occurs when the blood flow to your brain is interrupted becoming a “brain attack”. When blood supply does not reach a certain part, brain cells begin to die. Different types of stroke include ischemic strokes (blockage of blood vessel due to blood clot) or a mini stroke, a TIA (transient ischemic attack), with no permanent damage yet serious. Stroke also occurs when a blood vessel in the brain pops causing bleeding in the brain.

Certain areas of the brain can be affected by stroke and some symptoms of a stroke including cardiovascular disease, diabetes, and high blood sugar levels increase the risk of stroke whereas an active lifestyle or controlling high cholesterol reduces the risk. How well do you know stroke? Find tips to prevent and manage stroke, the differences in stroke screening tests, and the newer technology and treatments available. Come in for an easy consultation and further evaluation with our stroke specialist in Singapore at the Supreme Vascular and Interventional Clinic.

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Neurointerventional / Stroke Treatments

The Supreme Vascular and Interventional Clinic is your “go-to” facility for various neurointerventional / stroke conditions and treatments. To arrange an appointment with Dr. Manish Taneja, our stroke specialist, contact us. You can also call us at (+65) 6904 8084 for a consultation.